- GLP-1 weight loss appears to work after menopause: in the SURMOUNT-1 trial, postmenopausal women lost an average of 23% of body weight on tirzepatide vs 3% on placebo over 72 weeks.2
- In a small 2024 Mayo Clinic study, postmenopausal women on semaglutide who also used hormone therapy lost 16% vs 12% at 12 months. That is a link in records, not proof.3
- For hot flashes, there are no trial data on GLP-1 medicines. Talk to your clinician about hormone therapy and menopause symptoms.4
Why does weight shift around menopause?
The best long-term data come from SWAN, the Study of Women's Health Across the Nation, which followed US women through midlife with body scans. It found that at the start of the menopause transition, the rate of fat gain doubled and lean mass began to fall. These changes continued until about 2 years after the final period, then leveled off.1
One surprise: total weight did not climb faster at menopause. Fat went up while lean mass went down, so the scale moved at about the same pace as before.1 That helps explain why many women feel their body shape changes, especially at the waist, even when their weight barely moves.
Do GLP-1 medicines work after menopause? The tirzepatide data
The largest analysis comes from the SURMOUNT trials of tirzepatide (Zepbound, Mounjaro) in adults with obesity or overweight and without type 2 diabetes. Researchers went back and sorted women by reproductive stage. In SURMOUNT-1, that meant 697 premenopausal, 429 perimenopausal and 581 postmenopausal women, with a mean age of 58 in the postmenopausal group. Women on tirzepatide got 15 mg or the highest dose they tolerated, for 72 weeks.2
| SURMOUNT-1 women | Weight change | Waist change | Lost ≥5% of weight |
|---|---|---|---|
| Premenopause | −26% vs −2% | −22 vs −4 cm | 97–98% on tirzepatide vs 29–33% on placebo, across the three groups |
| Perimenopause | −23% vs −3% | −20 vs −5 cm | |
| Postmenopause | −23% vs −3% | −20 vs −4 cm |
The authors report similar results in SURMOUNT-3 and SURMOUNT-4. Three things limit this analysis. It was done after the fact, not planned. Most women were sorted into groups by age alone, not by hormone tests or symptoms. And it was funded by Eli Lilly, which makes tirzepatide, and most authors work there.2
For semaglutide (Wegovy, Ozempic), we did not find a published analysis of the STEP trials by menopausal status. A 2026 position statement from the Spanish Menopause Society, which reviewed the literature through April 2026, concluded that semaglutide has the most menopause-specific evidence among these medicines, but that this evidence is still limited and largely observational. It said tirzepatide is promising but needs menopause-specific study.4
Can GLP-1 help with menopause belly fat?
Waist size is a simple stand-in for belly fat. In SURMOUNT-1, postmenopausal women on tirzepatide lost an average of 20 cm (about 8 inches) from their waist, vs 4 cm on placebo.2 The analysis did not use scans to separate belly fat from other fat, so it cannot say how much of that was the deeper visceral fat linked to heart and metabolic risk.
Because lean mass already tends to fall during the menopause transition,1 the Spanish Menopause Society statement stresses resistance exercise and adequate protein alongside these medicines.4 See how much protein you need on a GLP-1 and GLP-1 and strength training.
GLP-1 and hormone therapy: the Mayo Clinic study
In 2024, Mayo Clinic researchers looked back at records of postmenopausal women with overweight or obesity who took semaglutide for at least 3 months. Sixteen were also using menopausal hormone therapy (estradiol as a patch or pill, with or without a progestogen) and 90 were not.3
The hormone therapy group lost more at every check-in, from 3 to 12 months, and the difference held after the researchers adjusted for other factors. Both groups saw improvements in blood pressure, glucose and lipids.3
The authors themselves say this design cannot show cause and effect. The hormone group was small. More women in that group reached the higher semaglutide doses of 1.7 to 2.4 mg (88% vs 66%), although that difference was not statistically significant.3 The 2026 Spanish Menopause Society statement calls the link hypothesis-generating and says it should not justify starting hormone therapy solely to increase weight loss.4
We found no trial testing tirzepatide together with hormone therapy.
What the labels say about taking them together
The US labels for Wegovy and Zepbound do not name menopausal hormone therapy as an interaction. In section 7.2, both say the medicine delays stomach emptying and may affect the absorption of oral medicines taken at the same time. The Wegovy label adds that, in clinical pharmacology trials, semaglutide 1 mg injection did not affect the absorption of the oral medicines tested.7 This is the labels' instruction to prescribers, not advice for you.
One 2025 case report described a 51-year-old woman on oral estrogen whose hot flashes and mood got worse while her semaglutide dose was being raised. Her symptoms settled after the dose increase was slowed. The author suggested a temporary drop in estrogen absorption, but a single case cannot prove that.5
Do GLP-1 medicines help hot flashes?
We do not know. We found no randomized trial of semaglutide or tirzepatide that measured hot flashes or night sweats as an outcome.
There is older evidence that weight loss itself may help. In the Women's Health Initiative, 17,473 postmenopausal US women aged 50 to 79 who were not on hormone therapy took part in a diet trial. Among those with hot flashes or night sweats at the start, women who lost 10% or more of their body weight in the first year were more likely to stop having them than women whose weight stayed the same (odds ratio 1.56).6 That weight loss came from diet, not medicine, and it was an observational analysis within the trial. Whether GLP-1 weight loss has the same effect has not been tested.
Common questions
Do GLP-1 medicines work for menopause weight gain?
In a post hoc analysis of the 72-week SURMOUNT-1 trial, postmenopausal women lost an average of 23% of their body weight on tirzepatide (Zepbound) vs 3% on placebo, similar to the 23% seen in perimenopausal women and 26% in premenopausal women. No trial has tested a GLP-1 medicine specifically for weight gain caused by menopause.
Does GLP-1 help with menopause belly fat?
In SURMOUNT-1, postmenopausal women on tirzepatide lost an average of 20 cm from their waist vs 4 cm on placebo over 72 weeks. Waist size is a rough marker of belly fat; the analysis did not scan fat directly.
Does semaglutide work better with hormone therapy?
In a 2024 Mayo Clinic records study of 106 postmenopausal women on semaglutide, the 16 using menopausal hormone therapy lost 16% of body weight at 12 months vs 12% for the 90 who were not. The study was small and retrospective, and a 2026 Spanish Menopause Society statement says this link should not justify starting hormone therapy only to boost weight loss.
Do GLP-1 medicines help hot flashes?
No randomized trial has tested semaglutide or tirzepatide for hot flashes. In the Women's Health Initiative, postmenopausal women who lost 10% or more of their weight were more likely to stop having hot flashes (odds ratio 1.56), but that was weight loss from diet, not medication.
Can you take a GLP-1 with hormone therapy?
The Wegovy and Zepbound labels do not list menopausal hormone therapy as an interaction, but both say these medicines delay stomach emptying and may affect how oral medicines are absorbed. A single 2025 case report described worse hot flashes in a 51-year-old woman on oral estrogen while her semaglutide dose was being raised. Decisions about hormone therapy belong with your clinician.
Sources
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. doi:10.1172/jci.insight.124865 · Full text (PMC)
- Tchang BG, Mihai AC, Stefanski A, et al. Body weight reduction in women treated with tirzepatide by reproductive stage: a post hoc analysis from the SURMOUNT program. Obesity (Silver Spring). 2025;33(5):851-860. doi:10.1002/oby.24254 · Full text (PMC)
- Hurtado MD, Tama E, Fansa S, et al. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause. 2024;31(4):266-274. doi:10.1097/GME.0000000000002310 · Full text (PMC)
- Sánchez-Prieto M, Romero-Domínguez M, Orozco R, et al. Incretin-based therapies in peri- and postmenopausal women with obesity: an expert position statement from the Spanish Menopause Society. Maturitas. 2026;213:109101. doi:10.1016/j.maturitas.2026.109101 · PubMed
- Parker AE. Worsening vasomotor symptoms in the setting of estradiol and semaglutide: a case report. Menopause. 2025;32(12):1168-1170. doi:10.1097/GME.0000000000002621 · PubMed
- Kroenke CH, Caan BJ, Stefanick ML, et al. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women's Health Initiative. Menopause. 2012;19(9):980-8. doi:10.1097/gme.0b013e31824f606e · Full text (PMC)
- US prescribing information: WEGOVY (revised 06/2026) and ZEPBOUND (revised 08/2026), section 7.2 Oral Medications (DailyMed, checked November 2026).
